Hand: Finger phalangeal shaft fractures

Fracture of the finger phalanges represent a risk of stiffness in 100% of cases. Treatment therefore must include early motion, if stiffness is to be avoided.

  • For nondisplaced fractures, when a splint is used initially, splinting duration must be short.
  • Displaced finger fractures usually require stabilization with pins, with subsequent early resumption of finger motion.

Case study: open comminuted intraarticular phalanx fracture

This is the case of a male in his 50's who injured his hand with a circular table saw.

This is what it looked like in the ER.

Thorough irrigation and debridement, repair of extensor tendons and lateral bands of both the long and ring fingers was carried out.

The ring finger fracture was exposed by the injury itself, and two little screws were placed before proceeding with the soft tissue repair. The radial condyle was reduced under direct vision, but additional soft tissue dissection for placement of screws was not desirable. Instead, I placed two percutaenous k-wires which provided good stability for the radial condyle.

Stable fixation with the screws and pins is what allows early motion and physicial therapy.

Patients sometimes ask how it's possible to move the finger with the pins "sticking out."

Not only is it possible, but it is the correct thing to do in the majority of these cases!!!

Here is a look at this patient's pictures at 3 weeks after surgery.

Note the still present swelling of the ring finger. After such an injury, edema is to be expected. Control of edema and range of motion exercises are part of the treatment. Early motion, physical therapy, is not the cause, but the solution to the problem.

Below the picture just after pin removal

In the picture below, just 2 weeks later, the edema has decreased considerably. There is less scaling, and better motion.

Here is the range of motion and appearance at a month and a half. Patient has almost full motion. The involved PIP joint moves fully. The deficit at the DIP is due to tightness/shortening of the extensor tendon.

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